By MARILYNN MARCHIONE
of the Journal Sentinel staff
Aug. 25, 2002
Like HMOs, designer clothes and gourmet foods, organ transplants aren’t just for people any more.
The University of Wisconsin-Madison and a half-dozen other veterinary schools around the country are doing kidney transplants for cats, and one or two are trying them for dogs.
The operations are expensive – $7,000 to $10,000 – plus $1,000 a year for lab tests and drugs to keep the animals from rejecting the new organs. Owners also must adopt the donor animal.
But three out of four kidney recipients survive long term, usually three to six years and some as long as a decade, and the surgery isn’t considered experimental for cats anymore.
Who would do this instead of euthanizing a pet with kidney failure?
People like Abigail Christiansen, a gastroenterologist in Middleton, who had a transplant last year for Bluebottle, a barnyard stray she and her husband, Lynn, adopted three years ago.
“It did sound outlandish” at first blush, she confessed. But being in the medical field, she viewed the treatment as less extreme than others might. “We don’t live very extraordinary lives in other respects,” she said.
And people like Lisa Reidel, a suburban Chicago pharmacist who arranged a transplant at UW for her cat, Spook, and now formulates his anti-rejection drugs herself.
“Spook was important to us. I thought about what we would do if he were human. Being a pharmacist, I’ve worked in hospitals all my life and I knew what options were available,” she said. When Spook developed kidney failure, “I wanted to explore every option, because I wasn’t ready to say goodbye.”
They’re typical clients, said Jonathan McAnulty, the veterinary surgeon who does kitty kidney transplants at UW.
“These are extremely rational, very practical people. You’d expect them to be crazy cat people,” but they’re not, he said.
As for the expense, people aren’t ridiculed for spending $40,000 or more on a car, so what’s irrational about people spending a fifth of that amount on a creature that brings them great joy, he asked. One of his earliest clients, for instance, was a 61-year-old woman with cancer who wanted to finish her life with the cat that had been her longtime companion.
“It’s a value judgment” on how to spend money, McAnulty said.
Reidel agreed, saying, “I’d give up 10 years of vacations” to extend her cat’s life. But not everyone saw it that way.
“I’ve had people say, ‘You’re a saint, you did the best thing you could for the animal,’ ” Reidel said. “My mom was the skeptical one. She told me I was crazy. I have some co-workers say, ‘You’re insane to do this. It’s just a cat.'”
Transplants are just one of many expensive and high-tech veterinary procedures that have become common at veterinary schools and hospitals in recent years. Chemotherapy, orthopedic surgeries, cardiology and neurology procedures, and a host of eye surgeries, including ocular lens implants, are done at the UW School of Veterinary Medicine, which is one of only 28 such schools in the nation.
“They do all sorts of cutting-edge things. You name it – if it’s done in humans, it’s done here,” McAnulty said.
“People worry when they come to a veterinary school that their animal is going to be experimented on. It’s totally inaccurate,” he said.
The reality is that such schools are the only places to find novel treatments such as kidney transplants, which are offered as a clinical service, not research or a teaching exercise. They charge a fee to cover their costs, just as a private clinic would, and the money goes back to the veterinary hospital’s operating budget.
The University of California, Davis, pioneered such operations in 1987, said the veterinary school’s transplant director, Lynda Bernsteen, who trained in Madison.
“We’ve done well over 100 now,” and one feline kidney recipient is “still going strong” 12 years after transplant, she said.
A half-dozen other schools and a few private veterinarian clinics have followed suit, including schools in Michigan, Pennsylvania, North Carolina, New York and Florida. UW started doing feline kidney transplants in 1995 and has done 40 since then, about one a month in recent years.
Most cost $7,000 to $8,000, but the tab climbs if there are complications and the cat must have transfusions, another operation or be hospitalized longer than the normal stay of three to four weeks.
From an organ-compatibility standpoint, cats are easy. They have three blood types – think of it as vanilla, chocolate and swirl – but “most are Type A, probably 80 percent to 90 percent of them,” Bernsteen said.
Dogs, on the other hand, have seven blood types and major and minor tissue types, so “you’re always transplanting across blood types,” McAnulty explained.
Dogs’ immune systems also are hypersensitive and easily provoked to reject an organ, which has made kidney transplants for them much rarer, he said. UC has done about a dozen since December 1999, and the University of Florida has tried at least one.
“We give people a 50-50 (chance), and right now we have four dogs” still alive, UC’s Bernsteen said. “We have not lost any to rejection at this point, but we have found that dogs can have other problems,” such as blood clotting issues, that can be fatal after transplant, she said.
Cat procedures more common
Canine transplants will remain less common until solutions to such problems are found. But feline transplants are becoming more common and are the only potential cure for kidney failure. Signs of such trouble can include excessive urination, increased thirst, nausea, vomiting, dehydration, hunching over the water bowl, loss of appetite, weight loss, muscle atrophy, poor hair coat, lethargy, weakness, depression, oral ulcers or convulsions.
Transplants can’t be done with the cat at death’s door and instead are attempted before the kidneys have shut down completely.
Age is not a barrier, as long as the cat is in good health otherwise. The average life span for cats is 17 years, but some live as long as 28 years, McAnulty said.
Many programs exclude cats that have had urinary tract infections because the immune suppression required after transplant could allow a low-grade infection to flourish and become fatal. At UW, cats are tested on the drugs before transplant to make sure no infections result.
Clients also must be prepared to accept the considerable burden of giving a cat pills twice a day to prevent rejection and taking the cat for regular lab tests to make sure immune suppression is adequate.
They must supply a cat (often a litter mate) to donate a kidney or adopt one that UW will procure from a firm that supplies lab animals. The donor’s remaining kidney enlarges and takes over about 75% of the function that two kidneys did before transplant, far more than what’s needed for a healthy life. “We would not kill a cat to take a kidney,” McAnulty said.
The donor cats have been young and adaptable, and have worked out well in their new homes, he said. People must sign agreements saying they’ll adopt the cat and treat it well. “These cats are going into homes where they really love cats,” and the experiences have been very good, he said.
Some people whose cats have had kidney transplants have formed the Feline CRF Information Center and have a Web site with information on chronic renal failure, dialysis and facilities that do transplants.
“Having gone through the experience of caring for a cat with CRF for nearly three years, we wanted to share what we learned with others who are faced with a similar situation. Our struggle was not easy, but we would not hesitate to do it again,” one couple writes on the site.
But as with any operation, there’s no guarantee of success. The Christiansens’ cat Bluebottle died of an infection 15 months after transplant. They’re still glad they had the extra time with him.
“He was an extremely sweet cat,” Lynn Christiansen said. “I just wish things worked out differently, but I’m not sorry we tried.”